It is possible, for example, that the results of the legislation will turn out to be unpleasant more quickly than most observers realize. The bill requires insurers to charge people with pre-existing conditions the same as everyone else, and the only reason for people not to game the system — dropping their insurance until they get sick and the insurer has to take them — is because the law requires them to buy insurance or pay a fine. For many people, the fine will be a cheap price to avoid premiums that could run around $8,000 a year for a family of four. The effect of the legislation could be to cause the number of healthy people with insurance to fall dramatically — and for premiums to rise, which would cause more people to drop their insurance. If this happens, we can expect liberals to agitate for a single-payer system; but we can also expect the public to blame the Democrats whose health-care system it will now be. A less lopsidedly Democratic Congress is not going to respond to this chaos by enacting single payer or strengthening the fines.

No small part of the current confusion between “health care” and medical care comes from failing to recognize that Americans can have the best medical care in the world without having the best health or longevity because so many people choose to live in ways that shorten their lives.